Ann Surg Treat Res.  2022 May;102(5):281-288. 10.4174/astr.2022.102.5.281.

Omission of neoadjuvant radiotherapy for clinical T2/N1 and T3N0/1 middle and low rectal cancers with safe circumferential resection margins

• Lee KH
• Kim JS
• Kim JY

• KMID: 2529682
• DOI: http://doi.org/10.4174/astr.2022.102.5.281

Abstract

Purpose
For moderately advanced rectal cancers with safe circumferential margins, the oncologic benefit of neoadjuvant radiotherapy must be reconsidered because of the possibility of overtreatment, resulting in complications from radiotoxicity. To evaluate the oncologic safety of the omission of neoadjuvant radiotherapy for moderately advanced rectal cancers, we evaluated and compared the prognoses of patients who underwent radical resection with and without neoadjuvant radiotherapy for T2/N1 and T3N0/1 middle and low rectal cancers with safe circumferential resection margins.
Methods
We retrospectively enrolled 66 patients who underwent radical resection for clinical (c) T2N1 and T3N0/1 middle and low rectal cancers between 2008 and 2014. Patients with distant metastasis; cT4, cN2, or positive lateral pelvic lymph nodes; positive circumferential resection margin; signet-ring cell carcinoma; cT1/2N0; or those who had received adjuvant radiotherapy were excluded. The clinical and pathological characteristics and 5-year oncologic outcomes of the noradiotherapy (n = 34) and radiotherapy (n = 32) groups were compared.
Results
The rates of abdominoperineal resection and ileostomies and the proportion of patients who received adjuvant chemotherapy were significantly higher in the radiotherapy group. There were no significant differences in tumor location, clinical stage, surgery type, pathologic N stage, anastomotic leakage, or long-term oncologic outcomes including 5-year disease-free survival, overall survival, and local recurrence and distant metastasis rates between both groups.
Conclusion
The oncologic benefit of neoadjuvant radiotherapy for cT2/N1 and T3N0/1 middle and low rectal cancers with safe circumferential resection margins is considered unclear, and it can be omitted to prevent radiotoxicity and facilitate prompt essential treatment.

Keyword

Neoadjuvant radiotherapy; Prognosis; Rectal neoplasms; Surgery

Figure

• 

  Fig. 1 The MRIs of rectal cancer. (A) Rectal cancer with T2N1. (B) Rectal cancer with T3N0/1 with safe circumferential resection margin.

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  Fig. 2 (A) Five-year disease-free survival (89.5% in the no-RT group vs. 79.4% in the RT group, P = 0.72). (B) Five-year overall survival (96.6% in the no-RT group vs. 89.0% in the RT group, P = 0.40). RT, radiotherapy.

• 

  Fig. 3 (A) Five-year distant metastasis rate (7.3% in the no-RT group vs. 15.3% in the RT group, P = 0.66). (B) Five-year local recurrence rate (6.9% in the no-RT group vs. 6.2% in the RT group, P = 0.55). RT, radiotherapy.

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